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Denies self image problems Question of Father as coach in HS ? Family issues

Calcium, vit d and OCP discussed ortho tricyclin OCP started

4 concussions with no brain rest, 10 hours/day of video games 3 serious concussions, never told anyone about ATV accident; symptomatic after all three; current return to play decision; chornic headaches, depression, loss of sleep 10 year-old cheerleader; precocious; very quick skill advancement; threw a move and “caused” a concussion in a 16 year old teammate

11.
Overview of Workshop
 The role of a sports psychologist in treating sports
medicine patients
 Discuss issues around professional development and
integration
 Discuss working in a medical milieu and working on a
treatment team
 An overview of sports medicine clinical topics
 Case presentations will be used as a teaching tool for
participants.

38.
Summer 04
(Freshman-Sophomore)
No running for 2 months
July started running 10 mi/ wk
Saw orthopedist for recurrent pain in
early August and MRI showed new
right sacral stress fracture
Started her on Actonel 35 mg per week
Instructed to not run for 3 months:

42.
Junior Year 1st
Semester
No pain on return, normal exam
including jump test
Uneventful semester maintaining wt at
110 with minimal pain
Ran modified with team, about 4 times
per week to a max of 25 miles per wk

43.
Junior Year 2nd
Semester
DEXA repeated and showed increased
density
Hip ↑ 4.4% to Z score of -1.2
Lumbar ↑ 2.2% (not clinically
significant) to Z -2.1
Stable weight about 115
Some hip and tibia pain with a normal bone
scan in February
Progressed to 50 miles per wk.

44.
Senior Year 2006-2007
Maintained her wt
well
Running about 40
mi/wk
November
developed a left
tibial stress
fracture
Now with right

45.
Female Athlete Triad
Studies have found
that 15 to 62% of
female college
athletes have
disordered eating.
3.4 to 66% of female
athletes are
amenorrheic.
At least 90% of peak
bone mass is

56.
AAN Return to Play Guidelines
Grade I: May return to play if symptoms clear within
15 minutes
Grade II: Terminate contest. May return to play if no
symptoms on exertion for one week
Grade III: Terminate contest. May return to play after
one week without symptoms if LOC < 1 min or 2
weeks if LOC > 1min (consider hospital evaluation)

57.
Return to Play with a
Second Concussion
Grade I: Terminate contest and return after
one week without symptoms at rest and
exertion
Grade II: Terminate contest and return after 2
weeks without symptoms at rest and
exertion
Grade III: Return after one month without
symptoms at rest and exertion

58.
Return To Play
Recommend injury grading in
retrospect
Symptom scores
Question the significance of
loss of consciousness
Significance of amnesia
Pediatric considerations

62.
Upper Extremity Overuse
Swimmers Shoulder
Constellation of instability
and impingement
Training may require 10 to
15 thousand yards per
day.
75% of this may be
freestyle
McMaster and Troup found
shoulder pain in:
10% of age 13- 14
13% of age 15- 16
26% of elite college
swimmers

63.
Upper Extremity Overuse
Swimmers Shoulder
Inflammation in the
supraspinatus and/or
biceps tendons
usually caused by
glenohumeral
instability
Supraspinatus ischemia
at the end of the pull
phase

64.
Upper Extremity Overuse
Swimmers Shoulder
Diagnosis
History of pain at
which part of the
stroke
Signs of impingement
and instability
Signs of rotator cuff
weakness and
inflexibility

66.
Upper Extremity Overuse
Swimmers Shoulder
Treatment
Technique:
1)Finish of the
stroke so that the
arm exits the water
at the iliac crest
2)Roll 70-
90 degrees
3) Entry just
outside the line of
the shoulder